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All Service Members Combat Lifesaver Medic/Corpsman Combat Paramedic/Provider
SCENE SETTER

#TCCC-ASM-13-01 1 AUG 19 2
 OPENING

Welcome to the TACTICAL COMBAT CASUALTY CARE

COURSE FOR ALL SERVICE MEMBERS (TCCC ASM)

SECDEF has directed ALL service members be trained and proficient

in basic lifesaving TCCC skills
TCCC ASM Course replaces current military first aid courses
This evidence-based training reflects the casualty care lessons of
nearly two decades of war and has the potential to significantly reduce
preventable prehospital trauma-related deaths
Invest fully in this course: the dividend will be in the lives saved

#TCCC-ASM-13-01 1 AUG 19 3
 CENTRAL OBJECTIVE

By the end of this course,

you will know the fundamental concepts of
TACTICAL COMBAT
CASUALTY CARE
and be able to perform
5 LIFESAVING SKILLS
at a basic competency level
#TCCC-ASM-13-01 1 AUG 19 4
 TACTICAL COMBAT CASUALTY CARE (TCCC)
ROLE-BASED TRAINING SPECTRUM

ROLE 1 CARE
NON-MEDICAL MEDICAL
PERSONNEL PERSONNEL

YOU ARE HERE

STANDARDIZED JOINT CURRICULUM

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 STUDENT LEARNING OBJECTIVES

10 TERMINAL LEARNING OBJECTIVES (TLOs)

01 02 03 04 05
Describe the Describe the use Perform a Demonstrate basic Demonstrate basic care
practice of TCCC of a first aid kit rapid casualty care for a casualty for a casualty with a
assessment with massive compromised airway or
bleeding in respiratory distress

06 07 08 09 10
Describe the basic Describe the Describe the Identify a head Describe point of
care of burns basic care of basic care of an injury injury communication
fractures eye injury strategies and casualty
care documentation

37 ENABLING LEARNING = Cognitive ELOs = Performance ELOs

OBJECTIVES (ELOs) #TCCC-ASM-13-01 1 AUG 19 6

 LIFESAVING SKILLS

You MUST be able to perform these

LIFESAVING SKILLS:
AIRWAY &
BLEEDING CONTROL
BREATHING

Rapid Tourniquet Hemostatic Pressure Airway

Casualty Application Dressing Dressing Maneuvers
Assessment

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 ASSESSMENT

HOW YOU WILL BE EVALUATED

The student must pass the

Skills Assessment of the
TCCC ASM Course

There is no formal, written

examination

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 Three PHASES of TCCC
are born out of years of war and lives lost:

1 CARE UNDER 2 TACTICAL 3 TACTICAL

FIRE/THREAT
NOT SAFE
Quick decision-making:
§ Ensure scene safety
§ Move casualty to safety
§ Identify and control
life-threatening bleeding
FIELD CARE EVACUATION
SAFER
CARE
Quick decision-making: Care provided during transport to
§ Provide medical aid advanced medical care,
wherever appropriate depending
on the trauma scenario
NOTE: This is covered in more
advanced TCCC training!

#TCCC-ASM-13-01 25 JUN 2019

 CASUALTY ASSESSMENT
PHASE 1: CARE UNDER FIRE OR THREATS
SCENE SAFETY HASTY
Using available TOURNIQUET
resources, ensure
scene safety For life-threatening
bleeding, place a TQ
Never attempt to
"high and tight" on the
rescue a casualty until
wounded extremity
the scene is SAFE
CASUALTY COMMUNICATION
MOVEMENT Check the casualty for
responsiveness and
reassure
Seek help
PLAY VIDEO
IMPORTANT
CONSIDERATIONS:
Order of actions will be
dictated by the situation
A casualty may be able
to perform self aid
Constantly assess
risks/threats and
make a plan before
moving a casualty
#TCCC-ASM-13-01 1 AUG 19 10
 CASUALTY ASSESSMENT

PHASE 2: TACTICAL FIELD CARE

M ASSIVE BLEEDING
(#1 Priority)
Use the MARCH sequence to
guide you through a
RAPID CASUALTY ASSESSMENT
A IRWAY

R ESPIRATION/BREATHING

C IRCULATION

H YPOTHERMIA
…then, tend to other injuries
11
#TCCC-ASM-13-01 1 AUG 19
 FIRST AID KITS

THESE ARE THE PERSONAL

MEDICAL SUPPLIES Joint First Aid Kit (JFAK)
YOU WILL NEED TO Individual First Aid Kit
PROVIDE AID: (IFAK)

Tourniquet
Hemostatic Dressing SERVICE-SPECIFIC
Pressure Bandage/
Emergency Trauma Dressing EXAMPLE:
Shipboard
DD Form 1380/ First Aid Box
Tactical Combat Casualty
Care Card
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 M A R C H

MASSIVE BLEEDING

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 MASSIVE BLEEDING

HOW TO RECOGNIZE
MASSIVE, LIFE-THREATENING BLEEDING
BRIGHT RED BLOOD Overlying clothing or ineffective
is pulsing, spurting or bandaging is becoming
steady bleeding from SOAKED WITH BLOOD
the wound

BRIGHT RED BLOOD AMPUTATION of

IMPORTANT! Casualties with
severe injuries can bleed to is pooling on the the arm or leg
death in as little as 3 minutes ground
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 MASSIVE BLEEDING

Three tools in your first aid kit can be used to

CONTROL MASSIVE BLEEDING!

TOURNIQUET HEMOSTATIC PRESSURE

DRESSING BANDAGE

M AR CH #TCCC-ASM-13-01 1 AUG 19 15
 MASSIVE BLEEDING

MOST COMMON
COMBAT APPLICATION TOURNIQUET

WINDLASS SINGLE
ROD ROUTING
BUCKLE
WINDLASS
CLIP WINDLASS
SAFETY STRAP
C-A-T® G7 NSN
6515-01-521-7976
(Combat Application
Tourniquet) M AR CH #TCCC-ASM-13-01 1 AUG 19 16
 MASSIVE BLEEDING

TOURNIQUET APPLICATION
A TOURNIQUET cuts off blood
flow to an arm or leg past the
application site; this is the best
method to control massive bleeding
APPLY A
TOURNIQUET AND
STOP BLEEDING
WITHIN
M AR CH
WHEN AND HOW TO APPLY
A TOURNIQUET (TQ):
CARE UNDER FIRE/THREAT
HASTY TQ “High and Tight” on
the wounded extremity or when
the bleeding source is uncertain
TACTICAL FIELD CARE
DELIBERATE TQ applied 2-3
inches above the wound
Apply a SECOND TQ if
bleeding is not stopped with
one properly applied TQ
(Note: a severe bleeding wound to
the thigh frequently requires a
SECOND TQ)
#TCCC-ASM-13-01 1 AUG 19 17
 MASSIVE BLEEDING

COMMON ERRORS WHEN PERFORMING

TOURNIQUET APPLICATION

#1 #2 #3
Self-adhering strap Windlass rod Tourniquet not
not pulled tight not twisted tight applied fast enough
(bleeding stopped at
enough at onset of enough to stop
application bleeding 1 minute; fully
secured at 3 minutes)

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 IMPROVISED TOURNIQUET

USE CAUTION RISKS ASSOCIATED

when considering WITH IMPROVISED
TOURNIQUETS:
the use of an
improvised DAMAGE may occur to skin
if the band is too narrow
tourniquet!
Bleeding may WORSEN
If no tourniquet is available,
pack the wound and hold direct Bleeding MAY NOT BE
pressure over the main source COMPLETELY CONTROLLED
of bleeding
An improvised tourniquet may
likely LOOSEN over time from not
being properly secured

M AR CH #TCCC-ASM-13-01 1 AUG 19 19
 WOUND PACKING AND PRESSURE BANDAGE

APPLY DIRECT PRESSURE WRAP BANDAGE tightly

AND PACK WOUND around injured extremity

PACK tightly using a
HEMOSTATIC Dressing
that contains a special
agent that promotes blood
clotting or a clean cloth, if
dressing not available
APPLY FIRM, DIRECT APPLY using short tugs evenly around the
PRESSURE for at least extremity while maintaining continuous
3 mins or until the tension on the bandage so pressure is
bleeding stops maintained
M AR CH #TCCC-ASM-13-01 1 AUG 19 20
M A R C H

AIRWAY

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 CLEARING THE AIRWAY

Ensure AIRWAY IS NOT BLOCKED

SIGNS AND
SYMPTOMS AIRWAY
MAY BE BLOCKED:
Casualty is in distress and
indicates they can’t breathe
properly

Casualty is making snoring

or gurgling sounds

Visible blood or foreign

objects are present in the
airway

IMPORTANT! Remove any Severe trauma to the face

visible objects, but do not
perform a blind finger sweep M A RCH
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 OPENING THE AIRWAY

In a CASUALTY without an airway obstruction,

you can perform the following maneuvers:
Assist a conscious For an unconscious
HEAD-TILT CHIN LIFT JAW-THRUST casualty not in shock,
casualty by helping
them assume any place them into the
comfortable sitting- RECOVERY
up position that POSITION
ALLOWS THEM TO
BREATH EASILY

M A RCH
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M A R C H

RESPIRATION

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 RESPIRATION/BREATHING

ASSESS FOR RESPIRATORY DISTRESS

SIGNS OF RESPIRATORY
DISTRESS INCLUDE:
Difficulty breathing

Struggling to get air in and out

Breathing is too weak to be effective

(less than 6 times per minute)

Rapid breathing
(greater than 20 times per minute)
LOOK - LISTEN - FEEL
THESE SIGNS MAY ALSO INDICATE A
PENETRATING CHEST WOUND INJURY
IMPORTANT! REPORT findings
of Respiratory Distress to
medical personnel at the scene
MA R CH
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 RESPIRATION/BREATHING

ASSESS FOR POTENTIAL

LIFE-THREATENING CHEST INJURIES
TYPES OF CHEST INJURY ROLL TO EXAMINE FRONT
AND BACK FOR SIGNIFICANT
TORSO TRAUMA
IMPORTANT

DO NOT pack
chest wounds
with a hemostatic
(or other) dressing
REPORT a
severe CHEST
INJURY to
Penetrating Blast medical personnel
immediately
MA R CH
Wounds Injury
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M A R C H

CIRCULATION

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 CIRCULATION/SHOCK

PREVENT SHOCK SIGNS AND SYMPTOMS

by controlling bleeding OF SHOCK INCLUDE:
Option: Consider
#1- Reassess all bleeding control elevating both legs
measures are still effective. Ensure higher than the
Rapid
tourniquets remain tight casualty's heart, if breathing
their airway
tolerates lying flat Losing focus
on their back and having
difficulty
Check radial pulse engaging
Sweaty, cool,
clammy skin
Pale/gray
skin
IMPORTANT! Alert medical
personnel for signs of shock MA R C H #TCCC-ASM-13-01 1 AUG 19
28
M A R C H
HYPOTHERMIA

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 HYPOTHERMIA PREVENTION

PREVENT/ADDRESS HYPOTHERMIA
worsened by MASSIVE BLOOD LOSS*
* This is not hypothermia due to cold weather

PREVENT HYPOTHERMIA:
Keep clothing on the casualty
unless its extremely wet, then
remove

Cover the casualty with blankets,

SOME SIGNS OF HYPOTHERMIA: poncho liners, sleeping bags, or
Slurred Slow
anything that will retain heat
speech or breathing & Shivering
mumbling drowsiness Keep casualty off the ground
(increases loss of body heat)
MA RC H
#TCCC-ASM-13-01 1 AUG 19 30
 In addition to
M A R C H

you may need to address

other injuries
#TCCC-ASM-13-01 25 JUN 2019 31
 SECONDARY INJURIES

eye trauma head injury burns fractures

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 SECONDARY INJURIES

IF A PENETRATING EYE INJURY IS NOTED

OR SUSPECTED, SHIELD THE INJURED EYE

IMPORTANT!
DO NOT APPLY
Rigid Eye PRESSURE
Shield

A B
Cover the eye with a RIGID EYE SHIELD, If no rigid eye shield is available,
not a pressure patch. Place the shield over the injured TACTICAL EYEWEAR can also be
eye (not both eyes) and tape in place used to protect the eye
#TCCC-ASM-13-01 1 AUG 19 33
 SECONDARY INJURIES

ASSESS FOR BURNS

BURNS ARE CLASSIFIED BY THE DEPTH OF THE WOUND.

SUPERFICIAL PARTIALTHICKNESS FULL THICKNESS

1ST DEGREE BURNS 2ND DEGREE BURNS 3RD DEGREE BURNS
are just like a sunburn, with will also have blisters may appear dry, stiff, and
a reddened appearance of leathery, and/or it can also
the skin be white, brown, or black

#TCCC-ASM-13-01 1 AUG 19 34
 SECONDARY INJURIES

BURN CARE
IN CASE OF
ELECTRICAL
INJURY

COVER COVER Secure the power, if possible.

the burn area the casualty to Otherwise, remove the casualty from the
with dry, sterile prevent heat loss electrical source using a nonconductive
object such as a wooden stick. Move the
dressings and keep the casualty to a safe place.
casualty dry
#TCCC-ASM-13-01 1 AUG 19 35
 SECONDARY INJURIES

ASSESS FOR A FRACTURE

WARNING SIGNS
OF A FRACTURE:
Significant pain and swelling

An audible or perceived “snap”

Different length or shape of limb
Loss of pulse or sensation in the
injured arm or leg
Crepitus (hearing a crackling or
popping sound under the skin)

CLOSED FRACTURE OPEN FRACTURE

#TCCC-ASM-13-01 1 AUG 19 36
 SECONDARY INJURIES

APPLICATION OF A SPLINT
A splint is used to prevent movement and hold an
injured arm/leg in place. Use a semirigid splint (like a
SAM splint) or improvise using rigid or bulky materials
(e.g., boards, boxes, tree limbs, and even weapons):
Incorporate the joint ABOVE AND BELOW
the fracture
SECURE THE SPLINT with an ace wrap, Arm fractures
cravats, belts, or duct tape (if available) can easily be
secured to the
Try to SPLINT before moving the casualty shirt using the
and minimize movement of the fractured extremity sleeve as a
sling
IMPORTANT! If the bandage is too tight, it can
decrease circulation to the fingers or toes
#TCCC-ASM-13-01 1 AUG 19 37
 SECONDARY INJURIES

ASSESS FOR HEAD INJURY

Result of blunt force,
SIGNS AND
Usually gunshot
acceleration, or wounds, SYMPTONS OF HEAD
deceleration forces stabbings, or INJURY INCLUDE:
(i.e., explosion or blast fragmentation
events, motor vehicle from explosives Altered consciousness
collision or roll-overs,
fall or sports injury) Disorientation or dizziness
Headache
BLUNT AND PENETRATING Ear ringing
HEAD TRAUMA Amnesia
Nausea/vomiting
Double vision
IMPORTANT! REPORT signs and symptoms of a
head injury to medical personnel at the scene
#TCCC-ASM-13-01 1 AUG 19 38
 COMMUNICATION AND DOCUMENTATION

COMMUNICATE: DOCUMENT:
1.WITH THE CASUALTY 1.CASUALTY
Encourage, reassure, and
ASSESSMENT
explain care
FINDINGS
2.WITH TACTICAL
LEADERSHIP 2.MEDICAL AID
Provide leadership with the RENDERED
casualty status and location
3.CHANGES IN
3.WITH MEDICAL CASUALTY STATUS
PERSONNEL
Discuss the casualty’s injuries Attach the DD Form 1380 to the
and symptoms, as well as any casualty’s belt loop, or place it in
medical aid provided with the their upper left sleeve or the left
responding medics DD Form 1380 trouser cargo pocket

#TCCC-ASM-13-01 1 AUG 19 39
 TEST ON KNOWLEDGE

You have encountered an active shooter situation.

An unconscious casualty has sustained multiple
gunshot wounds.

Your assessment reveals the following: two open chest wounds

from apparent gunshots, and bright red blood squirting from the
lower right thigh. The casualty is in respiratory distress.

What is the most important priority in the

care of this casualty?
1. Airway maneuvers
2. Wound packing of the right thigh
3. Tourniquet to the right thigh
4. Pressure dressing to the right thigh

#TCCC-ASM-13-01 1 AUG 19 40
 Using the …following the ...and providing

TCCC M A R C H LIFESAVING
SKILLS
standard of care in sequence to perform a
Prehospital Battlefield RAPID CASUALTY
Medicine ASSESSMENT

YOU can
SAVE A LIFE!
#TCCC-ASM-13-01 25 JUN 2019 41
 TACTICAL COMBAT CASUALTY CARE

YOUR JOB as a
First Responder is to
TAKE ACTION:
PROVIDE
5 TCCC LIFESAVING DOCUMENT ASSIST
SKILLS until medical medical aid with evacuation
personnel arrive
at the scene

#TCCC-ASM-13-01 1 AUG 19 42
 KEEP LEARNING

Use the Deployed Medicine

website and free mobile app to
access training materials and
instructional videos to sustain
knowledge and skills.

www.deployedmedicine.com

NLOAD
DOW DAY!
TO

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